El calcio y la vitamina D en la prevención y tratamiento de la osteoporosis

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La Osteoporosis (OP), no es una consecuencia normal de la edad sino una enfermedad prevalente que se asocia con una pobre calidad de vida con una alta morbimortalidad.

De hecho muchos autores consideran que la OP es una enfermedad pediátrica que se manifiesta en la edad adulta.

Las fracturas por OP son tan importantes como otras enfermedades como el IAM (infarto agudo al miocardio), accidente vascular cerebral (AVC) y cáncer de seno. El riesgo de una fractura osteoporótica en el transcurso de la vida es de un 40% en mujeres de 50 años y de un 13% en hombres. Y alrededor de 27% (una de cada tres) de los pacientes mueren en el año siguiente después de una fractura de cadera. El riesgo de una mujer de morir por una fractura de cadera (3%) es igual a las fallecidas por cáncer de seno y 3 veces más grande que el cáncer endometrial (1%).

Tanto la fractura de vertebral como la de cadera tienen serias consecuencias. Las vertebrales se asocian con dolor crónico en región dorsal y lumbar, pérdida de estatura, deformidad (joroba) y reducción de la función pulmonar, además de que el abdomen se protruye hacia delante. Hay también un detrimento en la calidad de vida. Similarmente, las fracturas de cadera (que han sido operadas) resultan en un dolor crónico, reducción de la movilidad y habilidad, con muchos pacientes necesitando el cuidado en casas de asistencia o por cuidadores especializados.

Sin embargo, los datos epidemiológicos sugieren que la OP permanece por mucho tiempo sub diagnosticada y sub tratada tanto en hombres como en mujeres. Consecuentemente los costos del tratamiento de la OP como tal son altos, y al menos tan significante como  aquellos asociados con otras enfermedades importantes como la EPOC (enfermedad pulmonar obstructiva crónica, el IAM, el AVC y el cáncer de seno, como hemos comentado.

El costo anual de una fractura de cadera se encuentra alrededor de los 900 millones de euros en países como Suecia, Francia y el Reino Unido. (Casi 20 mil millones de pesos mexicanos). En México, no se tienen datos epidemiológicos con respecto a las fracturas de cadera

No solo la OP es prevalente frente a otras enfermedades, pero es frecuente que también representa una amenaza para la sociedad en términos de morbilidad, mortalidad y costos económicos.

Pero, además si la amenaza de la OP continua aumentando en el mismo rango de ahora, se calcula que el número de fracturas de cadera para el año 2050 será cuatro veces más.

Es inaceptable, desde que se establece el diagnóstico y con terapias efectivas para la prevención y tratamiento de OP, que ya están disponibles, en México; que seguimos sin tratar adecuadamente al paciente osteoporótico. Por lo que respecta a la OP, esto debe ser un envejecimiento sin incapacidades.

Figura: 1

El calcio y la vitamina D son cruciales para la salud ósea.

El calcio determina el desarrollo de la masa ósea pico durante la adolescencia y ralentiza la pérdida ósea relacionada con la edad. En presencia de la deficiencia de la vitamina D, la absorción de calcio es impedida (hacia el hueso), y hay un aumento compensatorio en los niveles de la hormona paratiroides (PTH) que estimula la resorción del hueso y acelera la pérdida de hueso.

Y aunque la dieta, aunque baja de calcio y vitamina D, ambas son fácilmente corregibles, existe una característica común en todas las poblaciones; sus ingestas de estos dos componentes son deficientes.

Tanto el Instituto de Medicina de EU y las autoridades Europeas de salud, recomiendan 1000mg (1 gramo) de calcio diario para adultos por arriba de 50 años y 1200mg (1.2 gramos) para personas mayores de 60 años. También se recomienda que la vitamina D, deberá tomarse 400UI (Unidades Internacionales) para adultos de 50 años; 600UI de 51 a 70 años y 800UI de 70 años hacia arriba.

El calcio y la vitamina D (juntos) han probado su eficacia para prevenir fracturas y su inicio de acción alrededor de un año. Su efecto no es inmediato. El consumo de estos dos elementos resulta en un costo efectivo y benéfico para el paciente, considerando el tratamiento de fracturas por OP, ya sean vertebrales o de cadera.

Tomar el calcio aislado puede provocar depósitos de calcio en riñones, la vitamina D aislada puede ayudar a mejorar la fuerza muscular. La toma de vitamina C (ácido ascórbico) ayuda a eliminar la formación de cálculos en riñones (500mg diarios)

Las autoridades europeas reconocen la importancia del papel de ambos, y recomiendan que en cualquier estudio para conocer de otros nuevos medicamentos para tratar la OP, se deberán ingerir además, dosis adecuadas de calcio y vitamina D juntas.

La toma de conciencia tienen un papel esencial en decidir cuando el tratamiento es apropiado y asegurarse de que los medicamentos son tomados correctamente. La guía clínica disminuye el riesgo de dosis inapropiadas y mejora el cumplimiento a través de seguimiento a largo plazo. En contraste, el auto manejo de la OP es asociado con riesgos significativos, una preocupación importante es que si la decisión se deja a la persona, el tratamiento quizá nunca lo inicie en absoluto.

En un estudio que realizó la Fundación Internacional para la Osteoporosis (IOF) en el año 2000, mostró que en Europa, el 80% de las mujeres no creían que estuvieran en un riesgo para la OP.

Aquí mostramos una tabla mundial en que se muestra la falta de conciencia sobre la OP.

Figura: 2

Estos datos sugieren que si la decisión de tratar no es hecha por un médico, muchas personas están en riesgo de no recibir el tratamiento adecuado.

 

el 80% de las mujeres europeas no creen en lo personal que puedan ser víctimas de OP”

 

A pesar de la enorme carga de la OP en la sociedad, la encuesta de la IOF también demostró que la conciencia de la enfermedad es baja entre los médicos, con sólo un tercio discutiendo de la OP con sus pacientes. En un cuestionario personal que realice hace diez años, cuatro de cada diez médicos mexicanos, ni siquiera creían en la OP. “Es una mentira inventada por los Laboratorios” decían.

Las iniciativas educativas destinadas a mejorar esta situación, mediante la sensibilización sobre el diagnóstico y el tratamiento de la OP, pueden ser limitadas si permitimos que la auto medicación sea la que se imponga.

Se ha sugerido que el Calcio y la vitamina D, no son medicamentos como tal, y que solamente los antirresortivos (ARR) son los únicos que tratan la OP; pero se ha establecido que estos agentes (ARR) son menos efectivos ante la disminución de los niveles de calcio y vitamina D. Y hay que hacer notar que todos los estudios de los diferentes (ARR) que se han efectuado, en todos, se han suplementado con calcio y vitamina D, para su mejor absorción.

Los pacientes aceptan esta combinación sin problemas. Ya que solamente ministrar los (ARR), reducen sus beneficios y además cuestan bastante dinero.

Quizá como todavía no son considerados “medicamentos” tanto calcio como la vitamina D, los estándares de fabricación no sean totalmente exactos pero, para eso debe existir un Departamento de Calidad Farmacológica en la Secretaría de Salud, que certifique todos estos medicamentos genéricos; lo que significaría que la toma de estos preparados sea la adecuada y que reduzca el riesgo de OP tardía y que esto pueda ser fácilmente aplicado de cualquier forma.

Por lo pronto las autoridades sanitarias de Europa los tienen como medicamentos clave en el tratamiento de la OP.

 

Hay una necesidad clara para que el calcio y la vitamina D deben ser la terapia de prescripción bajo guía médica”

 

Conclusiones

La OP es una enfermedad que requiere supervisión médica continua para asegurar el éxito.

El calcio y la vitamina D han mostrado ser farmacológicamente activos, seguros y efectivos para la prevención y tratamiento de las fracturas osteoporóticas, cuando son dados a dosis adecuadas

El calcio y la vitamina D es la primera línea de medicación en la prevención y tratamiento de OP. Aunque en la mayoría de los pacientes con OP establecida, los beneficios serán mayores con la adición de un agente antirresortivo.

El costo beneficio de la adición de calcio más vitamina D es adecuado.

El conocimiento de la eficacia del calcio y de la vitamina D en el manejo de la OP, sigue siendo bajo y un trabajo adicional necesita ser realizado para aumentar la conciencia entre los médicos, los pacientes y las mujeres en peligro.

 

Marcas de Calcio + vitamina D en México

 

Medi Mart
Calcio comprimidos efervescentes 12 piezas de 500 mg c/u: $42.00

Caltrate-D tabletas de calcio 600 + con 400 UI de vitamina 
Carbonato de calcio/ vitamina D3. 60 tabletas: $195.00
Pfizer, S.A. de C.V.

Calcio /Vitamina D3
Tabletas 400mg/120UI  30 tabletas: $45.00
Farmacias del Ahorro

Calcio Sandoz 500mg
12 comprimidos efervescentes: $119.00
(Sandoz)

Os-Cal + D
Carbonato de calcio 500mg + Colecalciferol (vitamina D3)
60 tabletas (Sanofi Aventis)

Vitamina D3 (colecalciferol)
Tabletas de 1000 UI y 2000 UI
GNC

Valmetrol-3
Colecalciferol – (Vitamina D3) de 400UI, 600UI y de 800UI
Frasco con 50 tabletas: $110.50
Laboratorios Valdecasas, S.A.                                                   

Histofil tabletas 4000UI.
(Colecalciferol) Caja con 60 tabletas
Laboratorio Medix México.

 

 

 

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